非肌层浸润性膀胱癌整块切除术后行二次电切意义的Meta分析

Significance of second TURBT after ERBT for NMIBC:a Meta-analysis

目的系统评价膀胱肿瘤整块切除术(ERBT)标本中肌层组织存在率、二次电切时肿瘤残留率及分期升高率,以期为高危非肌层浸润性膀胱癌(NMIBC)的临床诊治提供参考。方法计算机检索Pubmed、Web of Science、Embase、中国知网、万方数据库的所有关于ERBT术后行二次电切的文献,检索时间均为建库至2020年7月20日。由2位研究员独立对每一篇符合纳入标准的文献进行质量评价和数据提取,并进行交叉核查。运用Stata 12.0软件及双反正弦法进行数据转换、发生率合并计算及单组率Meta分析。结果根据纳入标准最终纳入6项研究,共321例膀胱癌患者。结果显示ERBT术标本肌层组织存在率高达99.65%(95%CI:98.95%-99.98%),二次电切时肿瘤残留率为4.53%(95%CI 2.54%-7.04%),肿瘤分期升高率为1.57%(95%CI 0.51%-3.19%)。结论ERBT术标本肌层组织存在率较高、肿瘤残余率及分期升高率较低,但仍需要高质量大样本研究进一步明确ERBT可以避免或减少不必要的二次电切。

Objective To systematically assess the rate of detrusor muscle in the en bloc resection of bladder tumor(ERBT)specimens for non-muscle invasive bladder cancer(NMIBC),and the rates of residual tumor and upstaging in second transurethral resection of bladder tumor(TURBT),so as to provide reference for the clinical diagnosis and treatment of high-risk NMIBC.Methods Studies on second TURBT after ERBT were searched in PubMed,Web of Science,Embase,CNKI and WanFang database from the inception to July 2020.All data were extracted critically and independently by two reviewers according to the inclusion criteria.Stata12.0 software and double arcsine were used for data conversion,combined calculation of incidence rate and Meta-analysis.Results A total of 6 studies were included,involving 321 patients.The rate of detrusor muscle in the ERBT specimens was 99.65%(95%CI:98.95%-99.98%),the rate of residual tumor was 4.53%(95%CI:2.54%-7.04%),and the rate of upstaging in second TURBT was 1.57%(95%CI:0.51%-3.19%).Conclusion ERBT has advantages of increased rate of detrusor muscle in the surgical specimens and decreased rates of residual tumors and tumor upstaging.However,more studies are needed to confirm that ERBT may avoid or decrease unnecessary second TURBT.